Depression Flashcards
Correct or Not: depression is NOT normal consequence of aging
Correct
What’s the mnemonics for depression sx?
- S leep changes: increase during day or decreased sleep at night
- I nterest (loss): of interest in activities that used to interest them
- G uilt (worthless): depressed elderly tend to devalue themselves
- E nergy (lack): common presenting symptom (fatigue)
- C ognition/C oncentration: reduced cognition &/or difficulty concentrating
- A ppetite (wt. loss); usually declined, occasionally increased
- P sychomotor: agitation (anxiety) or retardations (lethargic)
- S uicide/death preocp.
Dysthymia - what is the timeline cutff>
> 2 years
Post stroke depression, where is the lesion?
L hemisphere lesion of the prefrontal cortex up to 2 years after CVA
How long the treatment should last?
- mono therapy preferred
- 6-12 month after remission
- most elderly will re maintenance therapy
First line treatment?
SSRI
Common side effects of SSRI
Parkinsonism, akathisia, anorexia, bradycardia, hypoNa, acute stroke risk, GI bleeding, fragility fracture
Special SE with Citalopram (Celexa)?
Prolonged QT
T or F? treating depression may impact medical mortality in cancer, stroke, and post-MI patients
T
Depression + Neuropathic pain
SNRI
2nd Line for depression
SNRI: venlafaxine (Effexor), duloxetine (cymbalta), mirtazapine (Remeron), buproprion (wellbutrin).
3rd line for depression
Aripiprazole (Abilify), quetiapine (Seroquel), buproprion or buspirone
Antidepressants to avoid in elderly
- Amitriptyline, doxepin, imipramine: for their anto-cholinergic effect, setting, and hypotensive effects
- TCAs: arrythmic, urine retention, orthostatic, may exacerbate dementia
Pt with psychosis, catatonia, Depression + Parkinsonism
ECT
Depression + Parkinson
Nortriptyline
How to Dx Depression based on DSM5
- 5/9 sx, one must be depressed sx or loss of interest
- Sx during the same 2 weeks period
- a change from previous function
Again, what are the precautions to take for starting patient on SSRI
- taking 4-6 wks after titling up to the dose
- may inc risk of hemorrhagic stroke
- check Na before start and after a few weeks of tx, prevent hyponatremia
- increase risk of GI and post-surgical bleeding
First drug of the first line
Sertraline (Zoloft)
What’s good and bad about prozac (fluoxetine)
- longer t1/2, better dosing schedule
- may exacerbate insomnia issue
T or F: Wellbutrin is safe in HT patients, but lower sz threshold
T
Duloxetine versus Effexor
D has more anticholinergic property, causing nausea, dry mouth
What’s typical presentation of elderly who is depressed?
MORE LIKELY TO: Give somatic complaints Feel worthlessness, rather than guilt Demonstrate hypochondriasis Have psychomotor retardation or agitation Manifest psychotic delusions
